Barriers and facilitators to engagement in psychological therapy in first episode psychosis: A meta-ethnography and qualitative comparative analysis.

Objectives: Disengagement from psychological therapies in first-episode psychosis (FEP) is a common occurrence, with personal costs associated with untreated problems. This study aimed to establish the barriers and facilitators of people experiencing FEP to engagement in psychological therapies by undertaking a meta-ethnography and Qualitative Comparative Analysis (QCA) of existing qualitative literature.

Methods: A systematic search was conducted in multiple databases including Psychinfo, Ovid Medline, Web of Science, EthOs, OPENgrey and Procrest in July 2021 (updated in July 2024). The search identified 6966 titles and 71 full texts that were reviewed for eligibility. Twenty-three studies were found to meet eligibility and were critically appraised. Data was systematically extracted and synthesized in a meta-ethnography and QCA.

Results: Seven themes were identified as barriers to engagement in psychological therapy (Ambivalence to therapy, Emotional distress, Fluctuating symptoms, Negative expectations, Physical capacity, Service limitations and Therapy preference unmet) and six themes were identified as facilitators (Destigmatizing, Accessibility of digital therapy, Positive expectations of therapy are met, Service factors, Therapists interpersonal approach and skills and Therapy preferences met). The QCA identified a model with the Therapists interpersonal approach and skills, as sufficient (i.e. whenever that condition is present, the outcome is also guaranteed to be present) for engagement in psychological therapy, while Emotional distress was a sufficient barrier to engagement.

Conclusions: Engagement is a multifaceted construct with many factors unique to an individual's experience, impacted by emotional, social, practical and service-level factors. Strengths, limitations and recommendations of the findings are discussed.